【罂粟摘要】术前碳水化合物负荷法和术中目标导向液体治疗对行开放胃肠道手术老年患者的影响:一项前瞻性随机对照试验
术前碳水化合物负荷法和术中目标导向液体治疗对行开放胃肠道手术老年患者的影响:一项前瞻性随机对照试验
贵州医科大学 高鸿教授课题组
翻译：张中伟 编辑：佟睿 审校：曹莹
目标导向液体治疗方案联合术前碳水化合物负荷法对老年患者术后并发症的影响尚不清楚；因此，设计此项试验来评估术前碳水化合物负荷法联合术中目标导向液体治疗（GDFT）与常规液体疗法(CFT)对老年患者胃肠道手术临床预后的影响。
试验纳入120例年龄大于65岁的胃肠道手术患者，随机分为CFT组(n= 60)和GDFT组(n=60)；CFT组采用传统的禁饮、禁食方法，而GDFT在手术前2 h服用碳水化合物(200ml);CFT组术中进行常规监测，而GDFT组采用Vigileo/FloTrac监测仪监测心脏指数(CI)、每搏量变异(SVV)和平均动脉压(MAP)，记录所有患者的人口统计学数据、术中参数及术后结果。
GDFT组与CFT相比：术中输入晶体液量明显减少(1111±442.9 ml 与 1411±412.6 ml；p<0.001)，尿量明显减少为(200ml[150–300] 与400ml[290–500]；p< 0.001)；此外，GDFT组首次排气较短为(56±14.1h 与 64 ±22.3 h; p= 0.002)，口服摄入量时间为 (72±16.9h 与 85±26.8 h; p=0.011)平均时长更短，还可降低患者术后并发症的发生率(15 (25.0%) 与 29(48.3%) p=0.013)；且两组间患者住院费用差异无统计学意义(p>0.05)。
对于进行开放胃肠道手术的老年患者，本研究发现围术期优化液体治疗可能与改善胃肠功能和降低术后并发症相关。
Preoperative carbohydrate loading andintraoperativegoal-directed fluid therapy for elderly patients undergoing open gastrointestinal surgery: a prospective randomized controlled trial
Abstract
Background: The effect of a combination of a goal-directed fluid protocol and preoperative carbohydrate loading on postoperative complications in elderly patients still remains unknown. Therefore, we designed this trial to evaluate the relative impact of preoperative carbohydrate loading and intraoperative goal-directed fluid therapy versus conventional fluid therapy (CFT) on clinical outcomes in elderly patients following gastrointestinal surgery.
Methods: This prospective randomized controlled trial with 120 patients over 65 years undergoing gastrointestinal surgery were randomized into a CFT group (n= 60) with traditional methods of fasting and water-deprivation, and a GDFT group (n= 60) with carbohydrate (200 ml) loading 2 h before surgery. The CFT group underwent routine monitoring during surgery, however, the GDFT group was conducted by a Vigileo/FloTrac monitor with cardiac index (CI), stroke volume variation (SVV), and mean arterial pressure (MAP). For all patients, demographic data,intraoperative parameters and postoperative outcomes were recorded.
Results: Patients in the GDFT group received significantly less crystalloids fluid (1111 ± 442.9 ml vs 1411 ± 412.6 ml;p< 0.001) and produced significantly less urine output (200 ml [150–300] vs 400 ml [290–500]; p< 0.001) as compared to the CFT group. Moreover, GDFT was associated with a shorter average time to first flatus (56 ± 14.1 h vs 64 ± 22.3 h; p= 0.002) and oral intake (72 ± 16.9 h vs 85 ± 26.8 h; p= 0.011), as well as a reduction in the rate of postoperative complications (15 (25.0%) vs 29 (48.3%) patients; p= 0.013). However, postoperative hospitalization or hospitalization expenses were similar between groups (p> 0.05).
Conclusions: Focused on elderly patients undergoing open gastrointestinal surgery, we found perioperative fluid optimisation may be associated with improvement of bowel function and a lower incidence of postoperative complications.